Table 1.
Contact tracer workforce for COVID-19 response in Nigeria, Rwanda, South Africa, and Uganda10,13,15,17
| Country | Contact tracer characteristics | Challenges | Solutions |
|---|---|---|---|
| Nigeria | Type: CHWs | Stigma and misinformation | Ongoing communication to communities in local languages using multiple platforms and multiple trusted voices |
| Contact-to-case ratio: 2 | Mistrust of political entities | Addressing fake news through trusted, authoritative public health voices and daily myth- busters | |
| Number/estimates nationwide (per state): average (range): 111 (30–304) | Overwhelming load of contact tracing and case detection workload for healthcare workers | Decentralization of screening and PCR testing by expanding capacity of existing laboratories and activating new PCR laboratories in every state | |
| % of tests positive (daily average) in January 2021: 7% in suspected cases; 11% in all contacts | Limited testing capacity | Further expansion of human resources and leveraging on partner funding and support | |
| Payment: no | Poor adherence to quarantine and isolation | ||
| Other incentives: stipends, training, certificates, and jackets | |||
| Rwanda | Type: volunteers and students | ||
| Contact-to-case ratio: 4 | Perceived and enacted stigma | Scale up community COVID-19 sensitization and barrier measures in public places involving both public and private authorities | |
| Number of contact tracers: 8/100,000 population | Overwhelming load of contact tracing and case detection workload for healthcare workers | Leveraging information technology to complement traditional contact tracing methods | |
| % of tests positive (daily average) in January 2021: 1.4 and 2% in contacts | Group of people (elderly) not able to remember all contacts | ||
| Payment: no | |||
| Other incentives: transport, phone communication, training, and refreshments | |||
| South Africa (Western Cape Province) | Type: varying categories including CHWs and volunteers | Staff anxiety for their risk of SARS-CoV-2 infection | Building local capacity to produce personal protective equipment |
| Contact-to-case ratio: 3 | Underutilization of quarantine facilities due to enacted stigma, fear of in-facility property loss, and unwillingness to isolate away from family | Education and ongoing communication to communities in local languages using multiple platforms, multiple players | |
| Number of contact tracers: 3/100,000 population | Overwhelming load of contact tracing and case detection workload for healthcare workers | Decentralized contact tracing activities and leverage of telephone contact tracing approach | |
| % of tests positive in suspected cases (daily average): at 1st peak high (July 2020) = 41%; between peak low (October 2020) = 4%; at 2nd peak high (January 2021) = 51% | Need for digital platform to host and share data across jurisdictions. | ||
| Payment: no—if volunteers, some already working for Department of health, but no extra payment given | |||
| Other incentives: training and reimbursement of calling costs incurred | |||
| Uganda | Type: CHWs, volunteers, students, and epidemiologists | Overwhelming load for contact tracing workforce and case detection workload for healthcare workers | Decentralized contact tracing activities to local health teams |
| Number of contact tracers: 186/100,000 population | Stigma | Community engagement and establishment of COVID-19 in every village across the country | |
| Contact-to-case ratio: 6 | |||
| % of tests positive (daily average): 10% in suspected cases. | |||
| Payment: no | |||
| Other incentives: stipends, training, certificates, T-shirts, badges/calendars, and study tour |
CHWs = community healthcare workers (includes community health extension workers and community health officers).